| 1. |
- Al-Mukhtar Othman, Jwan, 1980, et al.
(författare)
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Childhood nocturnal enuresis-a marker for pelvic floor disorders and urinary tract symptoms in women?
- 2021
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis A systematic survey on the association between childhood nocturnal enuresis (CNE) and adult pelvic floor disorders (PFDs) has not been presented previously. The aim was to describe the prevalence of PFDs and lower urinary tract symptoms in nulliparous women, with or without a history of CNE, at the age of >= 5 years. Methods This national survey of urinary (UI) and fecal incontinence (FI) and symptoms of pelvic organ prolapse (sPOP) was a random sample of 20,000 nulliparous women aged 25-64 years conducted in 2014. Women >= 5 years of age having CNE were compared with those without the condition. Fisher's exact test and logistic regression adjusted for BMI and age were used to analyze differences between groups. Results The response rate was 52% and 10.2% of adult women reporting CNE. One or more PFDs occurred in 38.3% of women with CNE compared to 23.8% in those without CNE (p < 0.0001). Mixed UI had the strongest association with CNE, odds ratio (OR) 2.63 (95% CI 2.03-3.40). The rate of FI was 11.2% in the non-CNE group and 16.8% in those with CNE (p < 0.0001) and sPOP 2.6% in the non-CNE and 4.8% in the CNE group (p = 0.0004), respectively. The prevalence of lower urinary tract symptoms was consistently higher in women with a history of CNE: overactive bladder 32.6% versus 18.4% (OR 2.34 95% CI 2.03-3.40), daytime micturition >= 8/day 29.6% versus 24.0% (p < 0.0001), and nocturia >= 2/night 12.4% versus 7.8% (p < 0.0001) in the CNE group. Conclusion PFDs and lower urinary tract symptoms in nulliparous women were approximately doubled in women with a history of CNE and could therefore act as a strong confounding factor.
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| 2. |
- Alexandridis, Vasileios, et al.
(författare)
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Adjustable mini-sling compared with conventional mid-urethral slings in women with urinary incontinence : a 3-year follow-up of a randomized controlled trial
- 2019
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 30:9, s. 1465-1473
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: The aim of this study was to compare the long-term subjective outcomes of an adjustable single-incision sling (Ajust®) vs standard mid-urethral slings (SMUS) for the treatment of women with stress urinary incontinence. Methods: This study was designed as a multicenter prospective randomized trial. Women under 60 years old with objectively verified stress urinary incontinence were included from seven centers in three countries. Women with mixed urinary incontinence were also included. Randomization was held in blocks for operation with either Ajust® or SMUS. Women analyzed at 1-year follow-up received the International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF), International Consultation on Incontinence Questionnaire Overactive Bladder, Pelvic Organ Prolapse/Urinary Incontinence/Sexual Function Questionnaire-12, Patient Global Impression of Severity, and Patient Global Impression of Improvement questionnaires, together with a bladder diary to fill out at least 3 years after the procedure. The main outcome evaluated was the subjective cure rate as reported through the ICIQ-UI-SF questionnaire at 3 years. Results: In total, 205 women participated in the 3-year follow-up: 107 in the Ajust® and 98 in the SMUS group. No significant difference was observed between the groups regarding subjective cure rate (50.9% vs 51.5%, p = 0.909) or dyspareunia. Both groups demonstrated similar postoperative perception of improvement in addition to reduced urgency and urge urinary incontinence. The postoperative improvement remained at the same level after 3 years as it was at 1-year follow-up for both Ajust® and SMUS. Conclusions: Ajust® appears to be equally effective and safe as SMUS with regard to long-term follow-up of patient-reported outcomes.
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| 3. |
- Alexandridis, Vasileios, et al.
(författare)
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Retropubic slings are more efficient than transobturator at 10-year follow-up : a Swedish register-based study
- 2023
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 34:6, s. 1307-1315
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: Long-term performance of mid-urethral slings (MUS) and potential differences between the retropubic and the transobturator technique for insertion are scarcely studied. This study aims to evaluate the efficacy and safety 10 years after surgery and compare the two main surgical techniques used. Methods: Women who underwent surgery with a MUS between 2006 and 2010 were identified using the Swedish National Quality Register of Gynecological Surgery and were invited 10 years after the operation to answer questionnaires regarding urinary incontinence and its impact on quality-of-life parameters (UDI-6, IIQ-7) and impression of improvement, as well as questions regarding possible sling-related complications and reoperation. Results: The subjective cure rate reported by 2421 participating women was 63.3%. Improvement was reported by 79.2% of the participants. Women in the retropubic group reported higher cure rates, lower urgency urinary incontinence rates and lower UDI-6 scores. No difference was shown between the two methods regarding complications, reoperation due to complications or IIQ-7 scores. Persisting sling-related symptoms were reported by 17.7% of the participants, most commonly urinary retention. Mesh exposure was reported by 2.0%, reoperation because of the tape by 5.6% and repeated operation for incontinence by 6.9%, significantly more in the transobturator group (9.1% vs. 5.6%). Preoperative urinary retention was a strong predictor for impaired efficacy and safety at 10 years. Conclusions: Mid-urethral slings demonstrate good results for the treatment of stress urinary incontinence and tolerable complication profiles in a 10-year perspective. The retropubic approach displays higher efficacy than the transobturator, with no difference regarding safety.
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| 4. |
- Altman, Daniel, et al.
(författare)
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A generic health-related quality of life instrument for assessing pelvic organ prolapse surgery : correlation with condition-specific outcome measures
- 2018
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 29:8, s. 1093-1099
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: The aim of this study was to investigate the use of a generic and globally accessible instrument for assessing health-related quality of life (HR-QoL) in pelvic organ prolapse (POP) surgery.Methods: In a prospective multicenter setting, 207 women underwent surgery for apical prolapse [stage ae2, Pelvic Organ Prolapse Quantificcation (POP-Q) system] with or without anterior wall defect. Demographic and surgical characteristics were collected before surgery. Results of the 15-dimensional (15D) instrument and condition-specific pelvic floor symptoms as assessed using the Pelvic Floor Distress Inventory questionnaire (PFDI-20), including its subscales Pelvic Organ Prolapse Distress Inventory-6 (POPDI-6), Colorectal-Anal Distress Inventory-8 (CRADI-8), and Urinary Distress Inventory-6 (UDI-6), were assessed preoperatively and 2 months and 1 year after surgery.Results: HR-QoL as estimated by 15D was improved 1 year after surgery (p < 0.001). Prolapse-related 15D profile-index measures (excretion, discomfort, sexual activity, distress, and mobility) were significantly improved after surgery (p < 0.05-0.001). Significant inverse associations were detected between increased 15D scores and a decrease in PFDI-20 and subscale scores (p < 0.001), indicating improvements on both instruments.Conclusions: Generic HR-QoL as estimated by 15D improved significantly after apical POP surgery and correlated with improvements of condition-specific outcome measures. These results suggest that a comprehensive evaluation of global HR-QoL is valid in assessing pelvic reconstructive surgery and may provide novel and important insights into previously understudied areas, such as cost-utility and cost-effectiveness analysis after urogynecological surgery.
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| 5. |
- Altman, Daniel, et al.
(författare)
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Anal sphincter lacerations and upright delivery postures - a risk analysis from a randomized controlled trial
- 2007
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 18:2, s. 141-146
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate obstetric sphincter lacerations after a kneeling or sitting position at second stage of labor in a multivariate risk analysis model. MATERIALS AND METHODS: Two hundred and seventy-one primiparous women with normal pregnancies and spontaneous labor were randomized, 138 to a kneeling position and 133 to a sitting position. Medical data were retrieved from delivery charts and partograms. Risk factors were tested in a multivariate logistic regression model in a stepwise manner. RESULTS: The trial was completed by 106 subjects in the kneeling group and 112 subjects in the sitting group. There were no significant differences with regard to duration of second stage of labor or pre-trial maternal characteristics between the two groups. Obstetrical sphincter tears did not differ significantly between the two groups but an intact perineum was more common in the kneeling group (p<0.03) and episiotomy (mediolateral) was more common in the sitting group (p<0.05). Three grade IV sphincter lacerations occurred in the sitting group compared to none in the kneeling group (NS). Multivariate risk analysis indicated that prolonged duration of second stage of labor and episiotomy were associated with an increased risk of third- or fourth-degree sphincter tears (p<0.01 and p<0.05, respectively). Delivery posture, maternal age, fetal weight, use of oxytocin, and use of epidural analgesia did not increase the risk of obstetrical anal sphincter lacerations in the two upright postures. CONCLUSION: Obstetrical anal sphincter lacerations did not differ significantly between a kneeling or sitting upright delivery posture. Episiotomy was more common after a sitting delivery posture, which may be associated with an increased risk of anal sphincter lacerations. Upright delivery postures may be encouraged in healthy women with normal, full-term pregnancy.
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| 6. |
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| 7. |
- Altman, Daniel, et al.
(författare)
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Anticholinergic drug use for overactive bladder in Sweden: a nationwide pharmacoepidemiological study
- 2009
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 20:11, s. 1285-1291
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Tidskriftsartikel (refereegranskat)abstract
- Nationwide use and costs of anticholinergic drug for overactive bladder are unknown. We performed a nationwide study based on the Swedish Register on Prescribed Pharmaceuticals. From 2000 to 2007, there was a 68.8% increase in dispensed anticholinergic drugs in a population of 9 million. More than 93 million DDDs (calculated average maintenance dose per day) of anticholinergic drugs were dispensed corresponding to an overall DDD/TID (DDD per 1,000 inhabitants per day) of 3.5 per 1,000 persons per year. Approximately two thirds of anticholinergic drugs were prescribed to women, regardless of drug type. In 2007, the cost for anticholinergic drugs was 22 million a,not sign of which tolterodine comprised 70.8%. Solifenacin and darifenacin steadily increased their DDD/TIDs after market introduction. In this nationwide study, there was a 70% increased rate of expedited prescriptions of anticholinergic drugs for the treatment of overactive bladder in a relatively stable population.
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| 8. |
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| 9. |
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| 10. |
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| 11. |
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| 12. |
- Altman, D
(författare)
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Surgery for cystocele II: replies
- 2012
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 23:6, s. 663-664
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Tidskriftsartikel (refereegranskat)
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| 13. |
- Altman, D, et al.
(författare)
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The impact of hysterectomy on lower urinary tract symptoms
- 2003
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Ingår i: International urogynecology journal and pelvic floor dysfunction. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 14:6, s. 418-23
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Tidskriftsartikel (refereegranskat)
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| 14. |
- Altman, D, et al.
(författare)
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The risk of anal incontinence in obese women
- 2007
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Ingår i: International urogynecology journal and pelvic floor dysfunction. - : Springer Science and Business Media LLC. - 0937-3462. ; 18:11, s. 1283-1289
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Tidskriftsartikel (refereegranskat)
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| 15. |
- Andrada Hamar, Maria, et al.
(författare)
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Short-term results of a prospective randomized evaluator blinded multicenter study comparing TVT and TVT-Secur
- 2011
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 22:7, s. 781-787
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: The aim of this prospective randomized multicenter study was to compare TVT (tension-free vaginal tape) with TVT-Secur in terms of efficacy and safety.Methods: We set out to enrol 280 stress incontinent women with a half time interim analysis of short-term cure and a continuous registration of adverse events. Of 133 randomized women, 126 were operated and 123 (TVT n = 62, TVT-Secur n = 61) available for 2 months follow-up.Results: No significant differences were found between groups regarding demographics or grade of incontinence. At 2 months follow-up, subjective cure rate following TVT-Secur was significantly lower than for TVT (72% and 92%, respectively, p = 0.01). Three major complications occurred in the TVT-Secur group: tape erosion into the urethra, a tape inadvertently placed inside the bladder, and an immediate postoperative bleeding from the corona mortis. No major complications occurred in the TVT group. No significant differences were found between groups regarding perioperative bleeding, hospital stay, urge symptoms, or postoperative urinary tract infections. Median time for surgery was 13 and 22 min for TVT-Secur and TVT, respectively (p < 0.0001).Conclusions: In a prospective randomized controlled study, the TVT-Secur procedure had a significantly lower subjective cure rate than the retropubic TVT procedure. Due to this, in addition to three serious complications in the TVT-Secur group, we decided to stop further enrolment after the interim analysis. We discourage from further use of the TVT-Secur.
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| 16. |
- Andrada Hamer, Maria, et al.
(författare)
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One-year results of a prospective randomized, evaluator-blinded, multicenter study comparing TVT and TVT Secur.
- 2012
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462.
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND HYPOTHESIS: The aim of this prospective randomized multicenter study was to compare retropubic tension-free vaginal tape (TVT) with TVT Secur in terms of efficacy and safety. METHODS: We set out to enrol 280 stress urinary incontinent (SUI) women with a half-time interim analysis of short-term cure and adverse events. The short-term results have previously been published. Of the133 randomized women, 125 underwent surgery, and 121 (TVT n = 61, TVT Secur n = 60) were available for follow-up 1 year postsurgery. RESULTS: No significant differences were found between groups regarding demographics or incontinence grade. One year after surgery, both subjective and objective cure rates were significantly lower for TVT Secur than for TVT (subjective cure: TVT 98 %, TVT Secur 80 %, p = 0.03; objective cure: TVT 94 %, TVT Secur 71 % for cough test, p = 0.01; TVT 76 %, TVT Secur 58 % for pad test, p = 0.05 ). Three major complications occurred in the TVT Secur group: one tape erosion into the urethra, one tape inadvertently placed into the bladder, and one immediate postoperative bleeding due to injury to the corona mortis. No major complications occurred in the TVT group. No significant differences were found between groups regarding peroperative bleeding, hospital stay, urge symptoms, residual urinary volume, subjective bladder emptying problems, postoperative urinary tract infections, and minor complications. The TVT Secur group used more antimuscarine medication after surgery than the TVT group (p = 0.03). Median time for surgery was 13 and 22 min for TVT Secur and TVT, respectively (p < 0.0001). CONCLUSION: The TVT Secur procedure had significantly inferior subjective and objective cure rates compared with the retropubic TVT procedure. Three serious adverse events occurred in the TVT Secur group. We therefore discourage further use of TVT Secur.
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| 17. |
- Andrada, Maria, et al.
(författare)
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Preoperative urethral parameters at rest and objective cure following laparoscopic colposuspension.
- 2010
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 21:3, s. 331-336
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND HYPOTHESIS: The aim of this study is to investigate associations between preoperative resting urethral parameters and objective outcome of laparoscopic colposuspension. METHODS: Data from 219 stress incontinent women who underwent laparoscopic colposuspension, with leakage at standardized pad test repeated after surgery, were collected. Associations between objective cure and preoperative maximum urethral closure pressure, functional urethral length, and continence area were analyzed using receiving operator characteristics curves. The level for 75% cure for each parameter was identified. RESULTS: All parameters were positively associated with cure. Continence area showed the strongest association. No cut-off values for prediction of failure were found. Women having levels equal or higher than the "75% cure level" for all urethral parameters had a cure rate of 88% compared with 55% for women with all parameters lower than this level. CONCLUSIONS: A combination of the urethral parameters may be useful for identifying patients with excellent chance for cure after colposuspension. Further studies are needed on continence area.
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| 18. |
- Ankarcrona, Victoria, et al.
(författare)
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Episiotomy in vacuum extraction, do we cut the levator ani muscle? : A prospective cohort study
- 2022
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Ingår i: International Urogynecology Journal. - : Springer Nature. - 0937-3462 .- 1433-3023. ; 33:12, s. 3391-3399
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis Vaginal delivery may lead to levator ani muscle (LAM) injury or avulsion. Episiotomy may reduce obstetric anal sphincter injury in operative vaginal delivery, but may increase the risk of LAM injury. Our aim was to assess whether lateral episiotomy in vacuum extraction (VE) in primiparous women causes LAM injury. Methods A prospective cohort study of 58 primiparous women with episiotomy nested within an ongoing multicenter randomized controlled trial of lateral episiotomy versus no episiotomy in VE (EVA trial) was carried out in Sweden. LAM injury was evaluated using 3D endovaginal ultrasound 6-12 months after delivery and Levator Ani Deficiency (LAD) score. Episiotomy scar properties were measured. Characteristics were described and compared using Chi-squared tests. We stipulated that if a lateral episiotomy cuts the LAM, >= 50% would have a LAM injury. Among those, >= 50% would be side specific. We compared the observed prevalence with a test of one proportion. Results Twelve (20.7%, 95% CI 10.9-32.9) of 58 women had a LAD (p < 0.001, compared with the stipulated 50%). Six (50.0%, 95% CI 21.1% to 78.9%) of 12 women had a LAD on the episiotomy side, including those with bilateral LAD (p = 1.00). Two (16.7%, 95% CI 2.1% to 48.4%) of 12 women had a LAD exclusively on the episiotomy side (p = 0.02). Conclusions There was no excessive risk of cutting the LAM while performing a lateral episiotomy. LAD was not seen in women with episiotomies shorter than 18 mm.
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| 19. |
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| 20. |
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| 21. |
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| 22. |
- Bohlin, Katja Stenstrom, et al.
(författare)
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Factors influencing the outcome of surgery for pelvic organ prolapse
- 2018
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Ingår i: International Urogynecology Journal. - : Springer London. - 0937-3462 .- 1433-3023. ; 29:1, s. 81-89
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Tidskriftsartikel (refereegranskat)abstract
- Pelvic organ prolapse (POP) surgery is a common gynecological procedure. Our aim was to assess the influence of obesity and other risk factors on the outcome of anterior and posterior colporrhaphy with and without mesh. Data were retrieved from the Swedish National Register for Gynecological Surgery on 18,554 women undergoing primary and repeat POP surgery without concomitant urinary incontinence (UI) surgery between 2006 and 2015. Multivariate logistic regression analyses were used to identify independent risk factors for a sensation of a vaginal bulge, de novo UI, and residual UI 1 year after surgery. The overall subjective cure rate 1 year after surgery was 80% (with mesh 86.4% vs 77.3% without mesh, p < 0.001). The complication rate was low, but was more frequent in repeat surgery that were mainly mesh related. The use of mesh was also associated with more frequent de novo UI, but patient satisfaction and cure rates were higher compared with surgery without mesh. Preoperative sensation of a vaginal bulge, severe postoperative complications, anterior colporrhaphy, prior hysterectomy, postoperative infections, local anesthesia, and body mass index (BMI) 30 were risk factors for sensation of a vaginal bulge 1 year postsurgery. Obesity had no effect on complication rates but was associated increased urinary incontinence (UI) after primary surgery. Obesity had no influence on cure or voiding status in women undergoing repeat surgery. Obesity had an impact on the sensation of a vaginal bulge and the presence of UI after primary surgery but not on complications.
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| 23. |
- Campbell, Jennifer, et al.
(författare)
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Patient-reported outcomes after sacrospinous fixation of vault prolapse with a suturing device : a retrospective national cohort study
- 2018
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 29:6, s. 821-829
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: Innovations in suturing devices have facilitated sacrospinous ligament fixation (SSF) for the correction of vaginal vault prolapse. It is uncertain if outcomes using suturing devices differ from those using a traditional suturing technique. We hypothesize that no difference exists in the efficacy and safety 1 year after SSF for vault prolapse performed with suturing devices or using a traditional technique. The objective was to compare SSF using a suturing device with traditional SSF for the treatment of vault prolapse, regarding symptoms of prolapse recurrence, patient satisfaction, incidence of re-operation, and complications 1 year postoperatively.Methods: We carried out a retrospective cohort study using register-based national data from 2006 to 2013. The Swedish Quality Register of Gynecological Surgery includes assessments pre-operatively, at hospital admittance, surgery, discharge, and questionnaires at 8 weeks and 1 year after surgery. Demographic variables and surgical methods were included in multivariate logistic regression analyses.Results: In the suturing device group (SDG, n = 353), 71.5% were asymptomatic of recurrence after 1 year compared with 78.7% in the traditional SSF group (TSG, n = 195); risk difference - 7.3% (95%CI -15.2%; 0.7%). Adjusted odds ratio (aOR) for being asymptomatic 1 year postoperatively was 0.56 (95%CI 0.31; 1.02, p = 0.057). Patient satisfaction was similar in SDG and TSG (78.1% vs 78.4%). Reoperation occurred in 7.4% in the SDG compared with 3.6% in the TSG, risk difference 3.8% (95%CI 0.0%; 7.5%), aOR 3.55 (95%CI 1.10; 11.44, p = 0.03).Conclusions: Patient satisfaction was similar 1 year after SSF, despite symptoms of recurrence being more likely and reoperation more common after using a suturing device compared with a traditional technique. The methods did not differ with regard to surgical complications.
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| 24. |
- Dahlgren, Hedda, et al.
(författare)
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Sexual function in primiparous women : a prospective study
- 2022
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 33:6, s. 1567-1582
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND HYPOTHESIS: The aim of this prospective study was to examine the impact of sociodemographic, pregnancy and obstetric characteristics on sexual function 12 months postpartum in primiparous women. We hypothesized that sexual function would decrease after childbirth.METHODS: Between 1 October 2014 and 1 October 2017, all nulliparous women in early pregnancy registering for maternity health care in Region Örebro County, Sweden, were invited to participate in this prospective study. A total of 958 women were included. Sexual activity and function were measured at early pregnancy, 8 weeks postpartum and 12 months postpartum using the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12). The associations between sociodemographic, pregnancy and obstetric characteristics and sexual activity and function from early pregnancy to 12 months postpartum were examined using linear and logistic models based on generalized estimating equations.RESULTS: We found that the prevalence of sexually active women decreased from 98.0% in early pregnancy to 66.7% at 8 weeks postpartum, but increased to 90.0% at 12 months postpartum. Age ≥ 35 years, second-degree perineal tear and current breastfeeding were statistically significant risk factors for sexual inactivity at 12 months postpartum. Poor self-reported health in early pregnancy was statistically significantly associated with decreased sexual function at 12 months postpartum.CONCLUSIONS: A majority of women resumed sexual activity at 8 weeks postpartum and most women at 12 months postpartum; the decrease in sexual function at 12 months postpartum was small and few risk factors were observed.
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| 25. |
- Daly, D., et al.
(författare)
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Learning about pelvic floor muscle exercises before and during pregnancy: a cross-sectional study
- 2019
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 30:6, s. 965-975
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesisAll pregnant women should be given advice on the benefits of pelvic floor muscle exercises (PFMEs) in preventing urinary incontinence (UI) and know how to exercise correctly. This study explored women's knowledge and practice of PFMEs, their sources of knowledge and prevalence of UI before and during pregnancy.MethodsWe conducted a cross-sectional study with 567 women, 239 primiparous and 328 multiparous, recruited from one maternity hospital in Ireland. Logistic regression was used to examine associations.ResultsPre-pregnancy, 41% of women (n=232) learnt to do PFMEs, 30% (n=172) did exercises and 28% (n=159) experienced UI. Women more likely to report UI were aged 35years (p=0.03), had a BMI 30kg/m(2) (p=0.01) or did PFMEs but were unsure they were exercising correctly (p=0.03). During pregnancy, 50% of women (n=281) received PFME information during antenatal visits and 38.6% (n=219) attended antenatal classes. Women less likely to do PFMEs daily or weekly had no formal educational qualification (p=0.01), did not do PFMEs pre-pregnancy (p<0.0001) or did not attend the physiotherapist-led PFME education session (p<0.0001). In multivariable analysis, the two factors significantly associated with UI during pregnancy were being aged 30-34years (p=0.05) and reporting UI pre-pregnancy (p<0.0001).ConclusionsThis benchmarking exercise revealed considerable gaps in the totality of PFME education and services offered in the site hospital. We recommend that others do likewise to enable learning from those who have addressed service deficits.
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| 26. |
- Daly, Deirdre, et al.
(författare)
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Urinary incontinence in nulliparous women before and during pregnancy: prevalence, incidence, type, and risk factors.
- 2018
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 29:3, s. 353-362
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Tidskriftsartikel (refereegranskat)abstract
- While many women report urinary incontinence (UI) during pregnancy, associations with pre-pregnancy urinary leakage remain under-explained.We performed a multi-strand prospective cohort study with 860 nulliparous women recruited during pregnancy.Prevalence of any urinary leakagewas 34.8% before and 38.7% during pregnancy.Prevalence of UI,leaking urine at least once per month,was 7.2% and 17.7% respectively. Mixed urinary incontinence (MUI) was reported by 59.7% of women before and 58.8% during pregnancy, stress urinary incontinence (SUI) by 22.6% and 37.2%, and urge urinary incontinence (UUI) by 17.7% and 4.0%, respectively. SUI accounted for half (50.0%), MUI for less than half (44.2%), and UUI for 5.8% of new-onset UI in pregnancy. Pre-pregnancy UI was significantly associated with childhood enuresis [adjusted odds ratio (AOR) 2.9, 95% confidence interval (CI) 1.5-5.6, p=0.001) and a body mass index (BMI) ≥30kg/m2 (AOR 4.2, 95% CI 1.9-9.4, p<0.001). Women aged ≥35years (AOR 2.8, 95% CI 1.4-5.9, p=0.005), women whose pre-pregnancy BMI was 25-29.99kg/m2 (AOR 2.0, 95% CI 1.2-3.5, p=0.01), and women who leaked urine less than once per month (AOR 2.6, 95% CI 1.6-4.1, p<0.005) were significantly more likely to report new-onset UI in pregnancy.Considerable proportions of nulliparous women leak urine before and during pregnancy, and most ignore symptoms. Healthcare professionals have several opportunities for promoting continence in all pregnant women, particularly in women with identifiable risk factors. If enquiry about UI, and offering advice on effective preventative and curative treatments, became routine in clinical practice, it is likely that some of these women could become or stay continent.
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| 27. |
- Daremark, Clara, et al.
(författare)
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Women's experiences of the injury, recovery and desire for rehabilitation after a second-degree vaginal tear-a qualitative study
- 2022
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 33:6, s. 1521-1527
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hyposthesis Eighty-five percent of all vaginal deliveries cause some form of obstetric tear injury. To our knowledge, there are no studies exploring experiences after second-degree tear. Therefore, our study aimed to investigate the experiences of a second-degree vaginal tear regarding aspects of the recovery and need for healthcare and rehabilitation. Methods Individual semi-structured interviews were performed and analysed with a qualitative, inductive descriptive approach. Results A group of 18 women with a second-degree vaginal tear after delivery were included. Four main categories with associated subcategories were found: (1) feeling uncertainty, with subcategories: not knowing what is normal, concern, confusion and uncertainty regarding pelvic floor muscle training; (2) feeling of security, with subcategories: I have no/I can handle the symptoms, trust in the healthcare system and I have sufficient knowledge; (3) not prioritizing myself, with the subcategories: I cannot find time and others have bigger problems; (4) lack of trust in healthcare providers, with the subcategories: feeling forgotten, not being taken seriously, distrust of the competence of the healthcare providers and resignation. Conclusion Women who suffer from a second-degree vaginal tear after pregnancy can feel safe when needs are met but uncertainty is also common when available healthcare and information are perceived as insufficient. The women also feel uncertainty about what is normal after the tear and how to perform pelvic floor exercises.
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| 28. |
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| 29. |
- Ekersund, J., et al.
(författare)
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A mobile app for the treatment of female mixed and urgency incontinence : a cost-effectiveness analysis in Sweden
- 2022
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Ingår i: International Urogynecology Journal. - : Springer Science+Business Media B.V.. - 0937-3462 .- 1433-3023. ; 33, s. 1273-1282
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: A previous randomized controlled trial (RCT) demonstrated that the app Tät II, for self-management of mixed urinary incontinence (MUI) and urgency urinary incontinence (UUI), yielded significant, clinically relevant improvements in symptom severity and quality of life (QoL) compared with a control group. We aimed to assess the cost-effectiveness of Tät II.Methods: A cost–utility analysis with a 1-year societal perspective was carried out, comparing Tät II with an information app. Data were collected alongside an RCT: 122 community-dwelling women aged ≥18 years with MUI or UUI ≥2 times/week were randomized to 3 months of Tät II treatment focused on pelvic floor muscle training (PFMT) and bladder training (BT; n = 60), or to an information app (n = 62). Self-assessed data from validated questionnaires were collected at baseline and at 3-month and 1-year follow-ups. Costs for assessment, treatment delivery, incontinence aids, laundry, and time for PFMT and BT were included. We calculated quality-adjusted life-years (QALYs) using the International Consultation on Incontinence Modular Questionnaire Lower Urinary Tract Symptoms Quality of Life. The incremental cost-effectiveness ratio (ICER) between the groups was our primary outcome. Sensitivity analyses were performed.Results: The mean age was 58.3 (SD = 9.6) years. Annual overall costs were €738.42 in the treatment group and €605.82 in the control group; annual QALY gains were 0.0152 and 0.0037 respectively. The base case ICER was €11,770.52; ICERs in the sensitivity analyses ranged from €−9,303.78 to €22,307.67.Conclusions: The app Tät II is a cost-effective treatment method for women with MUI and UUI.
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| 30. |
- Ekström, Å., et al.
(författare)
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Planned cesarean section versus planned vaginal delivery : Comparison of lower urinary tract symptoms
- 2008
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Ingår i: International Urogynecology Journal. - : Springer London. - 0937-3462 .- 1433-3023. ; 19:4, s. 459-465
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Tidskriftsartikel (refereegranskat)abstract
- We compared the prevalence and risk of lower urinary tract symptoms in healthy primiparous women in relation to vaginal birth or elective cesarean section 9 months after delivery. We performed a prospective controlled cohort study including 220 women delivered by elective cesarean section and 215 by vaginal birth. All subjects received an identical questionnaire on lower urinary tract symptoms in late pregnancy, at 3 and 9 months postpartum. Two hundred twenty subjects underwent elective cesarean section, and 215 subjects underwent vaginal delivery. After childbirth, the 3-month questionnaire was completed by 389/435 subjects (89%) and the 9-month questionnaire by 376/435 subjects (86%). In the vaginal delivery cohort, all lower urinary tract symptoms increased significantly at 9 months follow-up. When compared to cesarean section, the prevalence of stress urinary incontinence (SUI) after vaginal delivery was significantly increased both at 3 (p < 0.001) and 9 months (p = 0.001) follow-up. In a multivariable risk model, vaginal delivery was the only obstetrical predictor for SUI [relative risk (RR) 8.9, 95% confidence interval (CI) 1.9 - 42] and for urinary urgency (RR 7.3 95% CI 1.7 - 32) at 9 months follow-up. A history of SUI before pregnancy (OR 5.2, 95% CI 1.5 - 19) and at 3 months follow-up (OR 3.9, 95% CI 1.7 - 8.5) were independent predictors for SUI at 9 months follow-up. Vaginal delivery is associated with an increased risk for lower urinary tract symptoms 9 months after childbirth when compared to elective cesarean section. © International Urogynecology Journal 2007.
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| 31. |
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| 32. |
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| 33. |
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| 34. |
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| 35. |
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| 36. |
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| 37. |
- Foust-Wright, Caroline, et al.
(författare)
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Development of a core set of outcome measures for OAB treatment.
- 2017
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 28:12, s. 1785-1793
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Tidskriftsartikel (refereegranskat)abstract
- Standardized measures enable the comparison of outcomes across providers and treatments giving valuable information for improving care quality and efficacy. The aim of this project was to define a minimum standard set of outcome measures and case-mix factors for evaluating the care of patients with overactive bladder (OAB).The International Consortium for Health Outcomes Measurement (ICHOM) convened an international working group (WG) of leading clinicians and patients to engage in a structured method for developing a core outcome set. Consensus was determined by a modified Delphi process, and discussions were supported by both literature review and patient input.The standard set measures outcomes of care for adults seeking treatment for OAB, excluding residents of long-term care facilities. The WG focused on treatment outcomes identified as most important key outcome domains to patients: symptom burden and bother, physical functioning, emotional health, impact of symptoms and treatment on quality of life, and success of treatment. Demographic information and case-mix factors that may affect these outcomes were also included.The standardized outcome set for evaluating clinical care is appropriate for use by all health providers caring for patients with OAB, regardless of specialty or geographic location, and provides key data for quality improvement activities and research.
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| 38. |
- Franzén, Karin, 1958-, et al.
(författare)
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Electrical stimulation compared with tolterodine for treatment of urge/urge incontinence amongst women : a randomized controlled trial
- 2010
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Ingår i: International Urogynecology Journal. - Berlin, Germany : Springer. - 0937-3462 .- 1433-3023. ; 21:12, s. 1517-1524
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: Few randomized controlled trials have compared electrical stimulation treatment with drug therapy. Our hypothesis was that electrical stimulation treatment in women with urgency/urge incontinence would be more efficient compared to drug treatment.Methods: Women ≥18 years of age with urgency/urge incontinence were randomized to receive either ten electrical stimulation treatments vaginally and transanally over a period of 5-7 weeks or tolterodine 4 mg orally once daily.Results: Sixty-one women completed the study. There was no significant difference between the two treatment groups in micturition rate from baseline to 6 months, mean difference, -0.40 (95% confidence interval (CI), -1.61 to 0.82), but a clearly significant difference within each group for electrical stimulation, -2.8 (95% CI, -3.7 to -1.9), and for tolterodine, -3.2 (95% CI, -4.1 to -2.4).Conclusions: Both treatments reduced the number of micturitions, but electrical stimulation was not found to be superior to tolterodine.
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| 39. |
- Franzén, Karin M, 1958-, et al.
(författare)
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Surgery for urinary incontinence in women 65 years and older : a systematic review
- 2015
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 26:8, s. 1095-1102
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Forskningsöversikt (refereegranskat)abstract
- Introduction and hypothesis: Urinary incontinence (UI) is common among the elderly, but the literature is sparse on the surgical treatment of UI among the elderly. This systematic review aims to assess the effectiveness of surgical interventions as treatment for urinary incontinence in the elderly population ≥65 years of age.Methods: Randomized controlled trials (RCT) and prospective nonrandomized studies (NRS) were included. The databases PubMed (NLM), EMBASE (Elsevier), Cochrane Library (Wiley), and Cinahl (EBSCO) were searched for the period 1966 up to October 2013. The population had to be ≥65 years of age and had to have undergone urethral sling procedures, periurethral injection of bulking agents, artificial urinary sphincter surgery, bladder injection treatment with onabotulinumtoxin A or sacral neuromodulation treatment. Eligible outcomes were episodes of incontinence/urine leakage, adverse events, and quality of life.The studies included had to be at a moderate or low risk of bias. Mean difference (MD) or standard mean difference (SMD)as well as risk difference (RD) and the 95 % CI were calculated.Results: Five studies-all on the suburethral sling procedure in women- that fulfilled the inclusion criteria were identified. The proportion of patients reporting persistent SUI after surgery ranged from 5.2 to 17.6 %. One study evaluating quality of life (QoL) showed a significant improvement after surgery. The complication rates varied between 1 and 26 %, mainly bladder perforation, bladder emptying disturbances, and de novo urge.Conclusion: The suburethral sling procedure improves continence as well as QoL among elderly women with SUI; however, evidence is limited.
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| 40. |
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| 41. |
- Gyhagen, Julia, et al.
(författare)
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The influence of age and health status for outcomes after mid-urethral sling surgery-a nationwide register study.
- 2023
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 34:4, s. 939-947
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Tidskriftsartikel (refereegranskat)abstract
- The efficacy of mid-urethral sling (MUS) surgery in older women and women with a significant disease burden is limited. We aimed to determine the influence of chronological age and physical status (assessed by the American Society of Anesthesiologists Physical Status, ASA) classification on outcomes.Cure rate, change in frequency of lower urinary tract symptoms, satisfaction, impact, and adverse events after MUS surgery were assessed in 5200 women aged 55-94 years with MUS surgery (2010-2017). Data were analysed by multivariate logistic regression and Mantel-Haenszel chi-square statistics.The cure rate was 64.2% (95% CI, 60.0-68.4) in the ≥ 75-year cohort compared to 88.5% (95% CI, 87.1-89.8) in the 55-64-year cohort (trend p < 0.0001). The estimated probability of cure, improvement, and satisfaction with the procedure decreased by aOR10yr = 0.51 for cure to aOR10yr = 0.59 for satisfaction (all p < 0.0001). Women with a significant health burden (ASA class 3-4) had lower cure rates and satisfaction than those without (65.5% vs. 83.7%, p < 0.0001 and 65.7% vs. 80.6%, p < 0.0001). Older age was more likely to be associated with de novo urgency (p = 0.0022) and nocturia ≥ 2 (p < 0.0001). Adverse events, readmission, and 30-day mortality rates were low. Women, irrespective of age, were equally satisfied if they experienced a decrease of at least one step in leakage frequency.Even if MUS surgery in older women and those with ASA class 3-4 was associated with a lower cure rate and less satisfactory outcome, a majority were satisfied provided they experienced a reduction of incontinence episodes.
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| 42. |
- Gyhagen, Maria, et al.
(författare)
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Clustering of pelvic floor disorders 20years after one vaginal or one cesarean birth.
- 2015
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 26:8, s. 1115-1121
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Tidskriftsartikel (refereegranskat)abstract
- The objective was to assess the prevalence and risk factors for co-occurring pelvic floor disorders (PFDs): urinary incontinence (UI), symptomatic pelvic organ prolapse (sPOP), and fecal incontinence (FI), 20years after one vaginal (VD) or one cesarean (CS) delivery.
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| 43. |
- Gyhagen, Maria, et al.
(författare)
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Faecal incontinence 20years after one birth: a comparison between vaginal delivery and caesarean section.
- 2014
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462. ; 25:10, s. 1411-1418
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Tidskriftsartikel (refereegranskat)abstract
- The aetiology of bowel incontinence in middle-aged women is multifactorial and the contribution of birth-related factors later in life is still poorly defined. The aim was to assess prevalence, risk factors and severity of faecal (FI, defined as the involuntary loss of faeces-solid or liquid) and anal incontinence (AI, includes FI as well as the involuntary loss of flatus) 20years after one vaginal (VD) or one caesarean section (CS).
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| 44. |
- Gyhagen, Maria, et al.
(författare)
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The symptom of vaginal bulging in nulliparous women aged 25-64years: a national cohort study.
- 2019
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 30:4, s. 639-647
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Tidskriftsartikel (refereegranskat)abstract
- Vaginal bulging is considered the key symptom for genital organ prolapse. The aim was to investigate the age-related prevalence and frequency of symptomatic pelvic organ prolapse (sPOP) and other pelvic floor symptoms in nonpregnant nullipara aged 25-64years.This national postal and web-based questionnaire survey was conducted in 2014 and included four independent random samples of women aged 25-34, 35-44, 45-54, and 55-64years. The association of sPOP with demographics and with other pelvic floor conditions and with clustering to other pelvic floor conditions, was presented in women with and without sPOP. Logistic regression was used to identify and rank variables associated with symptomatic prolapse.The response rate was 52% (n=10,187) and 726 nullipara confirmed sPOP. Women with sPOP were younger (p<0.001), shorter (p<0.001), and more often overweight and obese (p<0.01) compared with asymptomatic women. Previous surgery for prolapse was reported by 15 women only (0.16%). Symptomatic POP decreased from 9.8% in the youngest age group (25-34years) to 6.1% in the oldest (55-64years) (p<0.0001). Symptomatic POP was more often experienced as bothersome (p=0.012), and aggravated by straining and heavy lifting (p=0.003), in older women. Vaginal/vulval chafing/rubbing feeling was most prevalent among the youngest 14.2%, decreasing to 7.8% among the oldest (<0.0001). This symptom occurred three to five times more often in those with sPOP (p<0.0001). Clustering of pelvic floor symptoms was four times more prevalent in women with sPOP (23.2% versus 6.1%) (p<0.0001).The high prevalence of sPOP in this study was contradictory to most earlier reports, which have shown that genital prolapse is rare in nullipara. The explanation of our results may be the low probability of the clinical condition, the dominance of weak and infrequent symptoms, and not least clustering of alternative conditions mimicking sPOP.
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| 45. |
- Halder, G. E., et al.
(författare)
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Validation of the Surgical Preparedness Assessment in women with pelvic floor disorders
- 2023
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesisWe sought to further develop and validate the Surgical Preparedness Assessment (SPA) scale to evaluate patient preparedness for urogynecological surgery. MethodsThis was a planned ancillary analysis of a randomized controlled trial (RCT) evaluating the impact of a preoperative telehealth call on patient preparedness for urogynecological surgery. Patients completed the Preoperative Preparedness Questionnaire (PPQ), the modified Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ), the Pelvic Floor Distress Inventory (PFDI-20), the Satisfaction Decision Scale (SDS), and the Decision Regret Scale (DRS). Content validity was established through expert opinion and patient cognitive interviews. Factor analysis identified item grouping into domains. Cronbach's alpha reported internal consistency. Known group validity was assessed by comparing intervention arms. External validity was evaluated by comparing intervention arms and correlations with SDS and DRS. ResultsEleven items and 3 domains met the criteria (information needs, satisfaction and pain, and catheterization). Cronbach's alpha values were acceptable for domains and ranged from 0.74 to 0.93. SPA scores did not correlate with other patient-reported outcomes. Mean SPA scores were lower among women who received a telehealth call vs those who did not (1.30 & PLUSMN; 0.31 vs 1.51 & PLUSMN; 0.44; p = 0.002). ConclusionsThe content-valid SPA demonstrates high internal consistency and known group validity.
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| 46. |
- Hannan, Johanna L., et al.
(författare)
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Impaired contraction and decreased detrusor innervation in a female rat model of pelvic neuropraxia
- 2017
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 28:7, s. 1049-1056
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: Bilateral pelvic nerve injury (BPNI) is a model of post-radical hysterectomy neuropraxia, a common sequela. This study assessed the time course of changes to detrusor autonomic innervation, smooth muscle (SM) content and cholinergic-mediated contraction post-BPNI. Methods: Female Sprague–Dawley rats underwent BPNI or sham surgery and were evaluated 3, 7, 14, and 30 days post-BPNI (n = 8/group). Electrical field-stimulated (EFS) and carbachol-induced contractions were measured. Gene expression was assessed by qPCR for muscarinic receptor types 2 (M2) and 3 (M3), collagen type 1α1 and 3α1, and SM actin. Western blots measured M2 and M3 protein expression. Bladder sections were stained with Masson’s trichrome for SM content and immunofluorescence staining for nerve terminals expressing vesicular acetylcholine transporter (VAChT), tyrosine hydroxylase (TH), and neuronal nitric oxide synthase (nNOS). Results: Bilateral pelvic nerve injury caused larger bladders with less SM content and increased collagen type 1α1 and 3α1 gene expression. At early time points, cholinergic-mediated contraction increased, whereas EFS-mediated contraction decreased and returned to baseline by 30 days. Protein and gene expression of M3 was decreased 3 and 7 days post-BPNI, whereas M2 was unchanged. TH nerve terminals surrounding the detrusor decreased in all BPNI groups, whereas VAChT and nNOS terminals decreased 14 and 30 days post-BPNI. Conclusions: Bilateral pelvic nerve injury increased bladder size, impaired contractility, and decreased SM and autonomic innervation. Therapeutic strategies preventing nerve injury-mediated decline in neuronal input and SM content may prevent the development of a neurogenic bladder and improve quality of life after invasive pelvic surgery.
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| 47. |
- Hansson Vikström, Nils, et al.
(författare)
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Anxiety and depression in women with urinary incontinence using E-health
- 2021
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Ingår i: International Urogynecology Journal. - : Springer. - 0937-3462 .- 1433-3023. ; 32, s. 103-109
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Tidskriftsartikel (refereegranskat)abstract
- Introduction and hypothesis: Previous studies have found high prevalence rates of anxiety and depression in women with urinary incontinence (UI). This study investigates the prevalence in women who had turned to eHealth for treatment of UI and identifies possible factors associated with depression.Methods: We analyzed data from two randomized controlled trials evaluating eHealth treatment for UI, including 373 women with stress UI (SUI), urgency UI (UUI), or mixed UI (MUI). We used the Hospital Anxiety and Depression Scale (HADS) and defined a score of >= 8 as depression or anxiety. The ICIQ-UI-SF questionnaire was used to score incontinence severity. Logistic regression was used to determine factors associated with depression and anxiety.Results: Women with UUI or MUI were older than women with SUI, mean age 58.3 vs 48.6 years (p = <0.001). Four out of five participating women had a university education. The prevalence of anxiety and depression in women with SUI was 12.4% and 3.2% respectively. In women with MUI/UUI, 13.8% had anxiety and 10.6% had depression. In multivariate analyses, the odds ratio of having depression was 4.2 (95% CI = 1.4-12.3) for women with MUI/UUI compared with SUI when controlling for other risk factors.Conclusion: The odds of depression in women with MUI/UUI were increased compared with SUI. The prevalence of anxiety and depression was considerably lower than reported in large cross-sectional surveys. Socioeconomic differences may partly explain this finding, as the use of eHealth still is more common among highly educated women.
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| 48. |
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| 49. |
- Hellberg, Dan, et al.
(författare)
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The very obese woman and the very old woman : Tension-free vaginal tape for the treatment of stress urinary incontinence
- 2007
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Ingår i: International Urogynecology Journal. - : Springer Science and Business Media LLC. - 0937-3462 .- 1433-3023. ; 18:4, s. 423-429
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Tidskriftsartikel (refereegranskat)abstract
- A mailed questionnaire was sent to 970 consecutive women who underwent a tension-free vaginal tape (TVT) procedure between 1995 and 2001 at the Department of Obstetrics and Gynecology in Falun Hospital. Seven hundred and sixty (78.4%) women responded. The outcome was compared between women older than 75 years (n=113) and younger women, and between women with a body mass index (BMI) above 35 (n=61) and those who had normal weight. Mean follow-up was 5.7 years. Thirty-six elderly women and one of the obese women were deceased at the long-term follow-up. TVT was easy to perform and was a safe procedure for women in all groups. There was a sharp decrease in cure rate of any urinary incontinence problems among women aged 75 years or more (55.7%), as compared to those who were younger (79.7%). The cure rate moderately decreased from BMI groups 19–24 to 30–34. BMI ≥35 seemed to be the best explanatory cutoff level. The overall cure rate in women of normal weight was 81.2%, as compared to 52.1% in the very obese. The cure rate for urinary incontinence with tension-free vaginal tape in women above 75 years of age and in women with a BMI above 35 was acceptable, but lower as compared to the remaining study population.
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| 50. |
- Hilde, Gunvor, et al.
(författare)
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Continence and pelvic floor status in nulliparous women at midterm pregnancy.
- 2012
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Ingår i: International urogynecology journal. - : Springer Science and Business Media LLC. - 1433-3023 .- 0937-3462.
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION AND HYPOTHESIS: A Cochrane review recommends antenatal pelvic floor muscle training (PFMT) in urinary incontinence (UI) prevention. The aim of the study was to investigate nulliparous pregnant women's knowledge about and practising of PFMT, their pelvic floor muscle (PFM) function, and ability to contract correctly. It was hypothesized that continent women had higher PFM strength and endurance than women with UI. METHODS: Three hundred nulliparous women at gestational week 18-22 were included in a cross-sectional study. Vaginal resting pressure, maximum voluntary contraction, and PFM endurance were measured by manometer. UI was assessed by International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICIQ-UI-SF). Comparisons of PFM function in continent women and women with UI were analyzed using independent-samples t test. Mean differences with 95% confidence interval (CI) are presented. RESULTS: Of 300 women, 89% had heard of PFMT at mid pregnancy, and 35% performed PFMT once or more a week. After thorough instruction 4% were unable to contract correctly. Thirty-five percent reported UI, of whom 48% performed PFMT once or more a week. Continent women had significantly higher PFM strength and endurance when compared with women having UI, with mean differences of 6.6 cmH(2)O (CI 2.3-10.8, p=0.003), and 41.5 cmH(2)Osec (CI 9.8-73.1, p=0.010), respectively. No difference was found for vaginal resting pressure (p=0.054). CONCLUSIONS: Most nulliparous pregnant women knew about PFMT. Thirty-five percent performed PFMT once or more a week. Incontinent nulliparous pregnant women had weaker PFM than their continent counterparts. More emphasis on information regarding PFM function and PFMT is warranted during pregnancy.
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